June 5, 2012

MRSA Incidence Reduced Among Elderly Patients By 82 Percent Over Nearly 3-Year Period

The introduction of daily bathing with disposable, germ-killing cloths resulted in a sustained, significant decrease in methicillin-resistant Staphylococcus aureus (MRSA) incidence at a Canadian geriatric facility, according to a poster presented at the 39th Annual Educational Conference and International Meeting of the Association for Professionals in Infection Control and Epidemiology (APIC).

Infection preventionists, working in the Acute Care Transition (ACT) unit at Baycrest, a geriatric healthcare system in Ontario, reduced the rate of MRSA transmission by 82 percent over a 33-month period.

Their results were achieved by daily bathing of patients with disposable cloths containing chlorhexidine gluconate (CHG), an antimicrobial that reduces organisms on a patient's skin and leaves a residue of the antimicrobial that lasts for up to six hours.

MRSA is a type of bacteria that is resistant to certain antibiotics and is a common cause of healthcare-associated infections.

The use of the wipes began as a pilot study in the 27-bed unit, which is dedicated to patients with complex sub-acute and chronic conditions that require urgent medical care. Prior to the study, there was a transmission rate of 4.99 cases per 1,000 patient days. After this intervention was introduced and became a standard of care, that rate was reduced to 0.88 cases per 1,000 patient days — an 82 percent reduction. It was an isolated intervention, with no other changes in practice on the unit.

The 1,000-bed facility screens every patient on admission to determine whether they are colonized with MRSA — meaning the organism is present in the body but not yet causing an infection. Lead study author, Heather Candon, M.Sc., CIC, infection prevention and control practitioner at Baycrest, said that the impetus for the bathing intervention came about after determining that 21 percent of the facility's MRSA transmission was occurring in the ACT unit.

"Because patients who are colonized with MRSA have a much greater chance of developing a MRSA infection, we knew we needed to intervene to stop transmission and prevent infection," said Candon. "Use of the CHG cloths proved to be a very effective way to achieve and sustain this reduction."

Candon added that previous reports had shown that bathing with CHG cloths reduced the risk of infections in patients undergoing surgery, but, to their knowledge, the technique had not yet been studied for reduction of MRSA transmission in a geriatric setting.

"The research presented by the Baycrest team represents a potentially promising intervention to reduce MRSA transmission and improve patient safety as part of an overall bundle of infection prevention strategies as identified by a facility's infection risk assessment," said Michelle Farber, RN, CIC, APIC 2012 president.